What Is Undifferentiated Schizophrenia?

Undifferentiated schizophrenia is a type of schizophrenia that is diagnosed when an individual meets the criteria for diagnosis of schizophrenia but cannot be classified into any of the five defined subtypes. People who are diagnosed with undifferentiated schizophrenia exhibit symptoms of more than one type of schizophrenia.

Definition of Undifferentiated Schizophrenia?

Schizophrenia is a mental health condition that interferes with a person's perception of reality. Previously, schizophrenia was divided into five subtypes as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association.

The five subtypes of schizophrenia:

• Paranoid: Positive symptoms like delusions and hallucinations are most dominant.
• Hebephrenic/disorganized: Cognitive and negative symptoms, such as disorganized thought, disorganized speech, and flat affect are most dominant.
• Residual: A person meets the criteria for a diagnosis of schizophrenia, but the symptoms are in a milder form.
• Catatonic: A person meets the criteria for schizophrenia and has additional symptoms of catatonia (excessive movement or decreased movement).
• Undifferentiated: A person exhibits the symptoms of more than one subtype of schizophrenia, but does not exhibit enough symptoms of one subtype to be classified as that subtype.

The most recent edition of the DSM (DSM-5) no longer includes these subtypes as distinct conditions because they were believed to have low validity and reliability in terms of diagnosis.

The five subtypes are still used by some clinicians as a way to understand how an individual's experience with schizophrenia is manifesting, and as a guide for discussing prognosis and tailoring treatment for each person.

Symptoms

For a diagnosis of any type of schizophrenia, a person must exhibit at least two of the following symptom types, with at least one of the symptoms being delusions, hallucinations, or disorganized speech.

The symptoms include:

• Delusions
• Hallucinations
• Disorganized speech (e.g., frequent derailment or incoherence)
• Grossly disorganized or catatonic behavior
• Negative symptoms (i.e., diminished emotional expression or avolition).

Symptoms must persist for at least six months and must cause significant difficulties in the level of functioning in one or more major life areas, such as work, interpersonal relations, or self-care.

People with undifferentiated schizophrenia can experience positive, negative, and/or cognitive symptoms, but their symptom pattern does not fit neatly into one of the other schizophrenia subtypes.

Positive Symptoms

This refers to behaviors and beliefs that are not normally present in healthy people.

Positive symptoms include:

• Hallucinations: A sensory experience that is not real, such as hearing voices, or seeing things that are not there.
• Delusions: Erroneous but firmly held beliefs, despite concrete evidence that disputes the belief or a lack of factual evidence to back up the belief. This might include thinking people on TV are sending special messages or it could involve paranoia, such as thinking people are spying on them or "out to get them".
• Thought disorder: Unusual thinking or disorganized speech.
• Catatonia or other movement disorders: Excessive movement or decreased movement.

Negative Symptoms

Negative symptoms refer to an absence of behaviors that are considered normal.

Negative symptoms include:

• Loss of motivation
• Social withdrawal
• Lack of interest or enjoyment in activities
• "Flat affect," reduced facial expression and/or vocal intonation
• Difficulty expressing emotion
• Difficulty planning activities
• Difficulty beginning and sustaining activities
• Reduced feelings of pleasure
• Reduced speaking

Cognitive Symptoms

Cognitive symptoms include substantial challenges with thinking skills.

Cognitive symptoms include:

• Problems with attention
• Difficulty concentrating or focusing
• Impaired memory, such as remembering appointments
• Diminished ability to process information
• Problems with decision making
• Difficulty learning and using information

Diagnosis

To determine if a person has schizophrenia, a mental health professional will consider several factors and diagnostic tests.

Examination

During an examination, a healthcare provider will:

• Ask about symptoms
• Review the person's medical history
• Review the person's family medical history
• Perform a physical examination
• Rule out other conditions besides schizophrenia

Lab Tests

There is no lab test that confirms or rules out a diagnosis of schizophrenia. Blood, urine, or other lab tests may be ordered to identify other possible conditions that may explain the person's symptoms.

Depending on the situation, a healthcare provider may order a blood or urine test to identify the presence of medications or illicit drugs that could be causing the symptoms.

Imaging Tests

A magnetic resonance imaging (MRI) or a computerized tomography (CT) may be ordered if there is concern that there could be an underlying physical cause for the symptoms, such as a brain tumor.

Causes

The specific cause of schizophrenia, and by extension undifferentiated schizophrenia, is not known, but there are several risk factors.

Age

While undifferentiated schizophrenia can occur at any age, symptoms usually begin during the age range of the late teens to the early thirties.

Genetics

Undifferentiated schizophrenia appears to run in families. Having schizophrenia in the family does not mean a person will develop schizophrenia, but it increases the risk.

Compared to the 1% prevalence of schizophrenia in the general population, there is a 10% prevalence among people who have a biological parent or sibling with schizophrenia. The highest risk is associated with identical twins.

Having a second-degree relative such as an aunt, uncle, grandparent, or cousin who has schizophrenia also increases a person's chances of developing the condition.

It is likely that multiple genes are involved in the development of schizophrenia.

Environment

It is believed that the interaction between genetics and environmental factors influences the development of undifferentiated schizophrenia.

Some environmental risk factors include:

• Living in poverty
• Living with stress
• Prenatal exposure to viruses or pathogens
• Prenatal malnutrition
• History of abuse or neglect

Substance Use

Drugs do not independently cause undifferentiated schizophrenia, but some drugs have been linked to an increased risk of schizophrenia in those who are susceptible.

Schizophrenia is linked most closely with use of:

• Cannabis
• Cocaine
• LSD
• Amphetamines

Research has shown a link between excessive use of cannabis by adolescents and the subsequent development of schizophrenia.

Brain Chemistry

Dysfunctions of the neurotransmitters dopamine, serotonin, norepinephrine, and epinephrine have been linked to undifferentiated schizophrenia.

More specifically, excessive dopamine activity is linked to hallucinations, agitation, and delusions, while abnormalities in norepinephrine are linked to negative and cognitive symptoms of schizophrenia.

Brain Physiology

Differences in brain structure and function are believed to play a part in undifferentiated schizophrenia.

For example:

• Differences in the volumes of specific components of the brain
• Differences in the way regions of the brain are connected and interact

These brain differences may begin before birth. Schizophrenia or other forms of psychosis may be triggered by changes to the brain during puberty in those who are susceptible due to genetics, environmental factors, or brain differences.

Treatment

Treatment options for schizophrenia can vary from person to person. Available treatment options are outlined below.

Medication

Medication, particularly antipsychotics, is the most common treatment for undifferentiated schizophrenia.

Antipsychotic medications can be taken in pill or liquid form, or by injection.

Some antipsychotics include:

• Zyprexa (olanzapine)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Geodon (ziprasidone)
• Abilify (aripiprazole)
• Invega (paliperidone)

Side effects of antipsychotics may include:

• Weight gain
• Dry mouth
• Restlessness
• Drowsiness 

Some people may be prescribed mood stabilizers such as:

• Lithobid (lithium)
• Depakote (divalproex sodium)
• Tegretol (carbamazepine)
• Lamictal (lamotrigine)

In some cases, people with undifferentiated schizophrenia may be prescribed antidepressants such as:

• Prozac (fluoxetine)
• Zoloft (sertraline)
• Paxil (paroxetine)
• Celexa (citalopram)
• Lexapro (escitalopram)
• Effexor (venlafaxine)
• Pristiq (desvenlafaxine)
• Cymbalta (duloxetine)
• Wellbutrin (bupropion)

Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy (CBT) is a type of ongoing therapy that can be effective for treating many psychiatric conditions.

With CBT, people who have undifferentiated schizophrenia can learn to identify maladaptive thought patterns and learn how to challenge them, and change the thoughts and their accompanying behaviors.

Family Education and Support

These programs are geared towards the family members and close friends of people who have schizophrenia. They aim to help loved ones understand the condition, learn ways to support the person who has undifferentiated schizophrenia, and find support for themselves.

These programs can be done individually, as a family, or as a group with other families.

Coordinated Specialty Care

This type of treatment involves a team of specialists working together to provide help such as:

• Psychotherapy
• Medication management
• Case management
• Employment and education support
• Family education and support

It may be particularly helpful for people in an early stage of schizophrenia called first-episode psychosis.

Assertive Community Treatment (ACT)

ACT aims to reduce the number of hospitalizations for people with undifferentiated schizophrenia and to decrease the number of people without housing.

It involves:

• A multidisciplinary team, including a medication prescriber
• A shared caseload among team members
• Direct service provided by team members
• A high frequency of contact with the person who has schizophrenia
• A low ratio between staff and the people with schizophrenia
• Outreach to people with schizophrenia in the community

Social Skills Training

This treatment uses rehearsing or role-playing real-life situations to help a person with undifferentiated schizophrenia re-learn how to act and interact appropriately in social settings.

Supported Employment

This program helps people with undifferentiated schizophrenia enter the workforce with support, such as assistance with constructing resumes, preparing for job interviews, and connecting them with employers who hire and support people with mental illness.

Substance Use Treatment

Excessive substance use can make undifferentiated schizophrenia symptoms worse. Up to 50% of people with schizophrenia have substance use disorders. Substance use treatment is often a part of the treatment program for undifferentiated schizophrenia.

Coping

Schizophrenia is a life-long condition, so finding coping strategies is important.

Some helpful tips for those living with undifferentiated schizophrenia include:

• With the help of professionals, create and maintain a treatment plan.
• If prescribed medication, take it regularly as directed and do not stop without consulting a healthcare provider.
• Eat a healthy diet. Consulting with a dietitian may be helpful.
• Get plenty of exercise. Exercise is good for both physical and mental health.
• Manage and minimize stress with techniques such as relaxation, knowing and respecting your limits, and managing your emotions.
• Get plenty of sleep.
• Avoid substances like alcohol, drugs, and smoking.
• Speak with a healthcare provider about changing or adjusting medications if you are not noticing improvement or if your medications are causing bothersome side effects.
• Set goals and work towards them.

Finding Support

Living with undifferentiated schizophrenia is difficult to do alone. Having the support of others can make treatment and management of undifferentiated schizophrenia more effective, and make life with schizophrenia more enjoyable.

Some ways to find support include:

• Reaching out to trusted friends, family, and loved ones
• Joining activities or groups involving things you enjoy such as sports, volunteering, or hobbies
• Joining local clubs or organizations
• Finding a living environment that makes you feel safe and supports your needs, whether that means living alone, community or supportive living, living with friends or family, or something else
• Contacting support services in your area

A Word From Verywell

Undifferentiated schizophrenia can be hard to recognize and difficult to live with, but with proper support and treatment, it can be manageable.

If you are experiencing symptoms of undifferentiated schizophrenia, book an appointment to see your healthcare provider or a mental health professional to get a proper diagnosis, and find a treatment plan that works for you.